No. 3:15-cv-1468-JAM, filed October 9, 2015 Issue: Whether the extremely high denial rates (98% and higher) at the redetermination and reconsideration stages of administrative review for home health care claims violate the Medicare statute and the … [Read more...] about Olsen-Ecker v. Burwell
Litigation
Bremby v. Burwell
No. 3:15-cv-01397 (DJS), filed September 22, 2015 Issue: Whether the Secretary violated the Medicare statute and the Due Process Clause by not recognizing that Vitamin B-12 injections represent a per se skilled nursing service and therefore the … [Read more...] about Bremby v. Burwell
Lodge v. Burwell
No. 3:15-cv-00390-JBA (D.Conn.), filed March 17, 2015 Issue: Whether extraordinary dental care should be covered because the exclusion for coverage of dental care should be limited to routine dental care. Relief Sought: Reversal of the Secretary’s … [Read more...] about Lodge v. Burwell
Ryan v. Burwell
No. 5:14-cv-269 (D.Vt.), filed Dec. 19, 2014 Issue: Whether the failure of the Secretary to apply the “prior favorable homebound decision” rule, which accords “great weight” to previous administrative decisions establishing homebound status, … [Read more...] about Ryan v. Burwell
Lessler v. Burwell
No. 3:14-cv-01230 (D.Conn.), filed August 26, 2014 Issue: Whether the consistent failure of administrative law judges (ALJs) to issue decisions within 90 days of the request for ALJ review (with an average delay now approaching 500 days) … [Read more...] about Lessler v. Burwell
Haro v. Johnson
No. 09-cv-134-TUC-DCB (D.Ariz.), filed March 10, 2009. Appeal filed June 30, 2011 (No. 11-16606, 9th Cir.). Issue: Whether the Secretary's aggressive methods for attempting to collect payments under his Medicare Secondary Payer (MSP) program, … [Read more...] about Haro v. Johnson
Hull v. Sebelius
No. 14-801 (D.Conn.), filed June 4, 2014 Issue: Whether the Secretary of Health & Human Services’ denial rate of about 98% at the lowest two levels of appeal in Medicare’s system of administrative review (redetermination and reconsideration) … [Read more...] about Hull v. Sebelius
New Beneficiary Help Line for ALJ Appeals Results from CMA Litigation
Pursuant to the settlement agreement in Exley v. Burwell, a class action brought by the Center to address delays in appeals at the Administrative Law Judge (ALJ ) level, the Office of Medicare Hearings and Appeals (OMHA) has established a new help … [Read more...] about New Beneficiary Help Line for ALJ Appeals Results from CMA Litigation
Exley v. Burwell: Settlement In Medicare Appeals Delay Case Granted Final Approval
On August 1, 2016, Judge Jeffrey Meyer of U.S. District Court in Connecticut granted final approval to a settlement agreement that will ensure timely decisions for Medicare beneficiaries who appeal denials of coverage to Administrative Law Judges … [Read more...] about Exley v. Burwell: Settlement In Medicare Appeals Delay Case Granted Final Approval
Federal Court Issues Favorable Off-label Part D Drug Coverage Decision
The Medicare Advocacy Project of Greater Boston Legal Services recently received a favorable decision from the U.S. District Court in Massachusetts for “off-label” coverage of the drug Dronabinol. This is a welcome development given … [Read more...] about Federal Court Issues Favorable Off-label Part D Drug Coverage Decision